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Amazing Low Back Exercises to Try Right Now.

Sometimes coming up with exercises in your clinic room can be difficult. Even more difficult is finding some that you can recommend as good home care.

Last week we went over how to do a great exercise called the “Dead Bug”.

This week we’re basically going to flip that over and progress the exercise to something called the “Bird Dog”.

What I love about these, is you can do it right on your table, and they’re easy for a patient to do at home.

Once your patient is confident with doing this exercise on top of the swiss ball, we can make things more difficult by removing the swiss ball.

This can still be easily done on your table in your clinic room, but it’s just a bit more difficult and will build a bit more confidence than when you’re using the swiss ball.

 

Now we can ramp things up just a bit more after your patient is confident with these movements.

By using an exercise band we can make things just a little more difficult and still build more confidence in movement with our patients.

Give these a try.

Doing movements like these will reinforce everything you did with your hands on the table and bring about greater outcomes with your patients.

If you’d like to learn more on how to incorporate more things like this into your treatments, and generate greater outcomes, register for our newest online course “Clinical Applications Of Pain Management Using Therapeutic Movement” by clicking HERE

An Attempt At Simplifying Central Sensitization

 

Have you ever had one of those appointments where you’re not sure of the outcome or the patient interaction?

I remember having a patient back in college who would come in for treatment of back pain. The person was in their early 20’s and told me they were dealing with chronic pain in the area. 

During the first treatment, as soon as I put my hands on them and pressed down, they quickly informed me that was too much pressure! So, of course, I backed off and used a much gentler touch. 

I felt like I was barely touching them. 

So, I treated the person a few times; then, they booked in with one of my classmates. 

However, during their treatment, the patient said “your treatment was okay, but you don’t use as much pressure as Jamie”!

We were both perplexed as my classmate said they were using very light touch (I think I had put something in the treatment notes about pressure). 

Neither of us could figure out what was the correct approach. There is a chance this was just therapist preference, but there’s also the possibility of something called Central Sensitization. 

Understanding Pain

It’s probably important to start by talking about Nociception. 

Nociception itself is not pain; it is the detection of noxious stimuli, which is a protective response that generates a reflex withdrawal to get us to stop doing whatever thing we are doing that could cause tissue damage. (1) Another result of this is it helps us avoid doing those things again (think the first time you put your hand on a hot stove, and will likely never do that again). 

When sensitization of this nociceptive system is repeated or more intense than usual, then the amount of stimulus needed to create pain decreases and becomes amplified. (1)

So, for Central Sensitization to occur, an intense stimulus has to happen repeatedly over an extended period. (1) Think of something like jabbing your forearm with a sharp pen for a couple of minutes (don’t actually do it, I’m just giving examples!). Doing the same thing with the pen for 5 seconds won’t have the same result. 

When this happens, it leads to Nociception no longer being a protection, and pain can arise out of nowhere. 

This can result in allodynia and hyperalgesia, and it is necessary to recognize the difference between the two. 

Hyperalgesia is where an increased response at a normal threshold or increased threshold creates an enhanced pain sensitivity. This is common for things like neuropathy. 

Allodynia is pain from something that shouldn’t be painful. Like the touch of a feather, as you can see in the image below.(2) 

 

Image from: Tsagareli, Merab. (2013). Pain and memory: Do they share similar mechanisms?. World Journal of Neuroscience. 3. 39-48. 10.4236/wjns.2013.31005.  

 

As well, pain can be exaggerated and prolonged because of its response to noxious stimuli and can spread to other parts of the body, which is called secondary hyperalgesia

The research papers cited show a whole host of molecular changes and activities in the spinal cord that lead to CS, but I’m not sure we have to know those specifics. It is important to know that these changes are happening in the dorsal horn of the spinal cord which is sending signals to the brain. 

Another essential takeaway is how there is no single defining mechanism; it’s a general phenomenon that changes how a stimulus is interpreted. 

So, how often have you had a patient come in where maybe their pain experience didn’t make sense? Perhaps their arm hit the door as they walked in, and it was excruciating? Maybe their description of what they are going through didn’t make sense? 

Well, this may be in part because of some CS occurring with them. Because tissue injury is not necessary, and pain can be maintained even though there isn’t any injury that has happened (recently), these may be signs that something more is going on. 

However, we aren’t able to diagnose this, but it may be vital for us to recognize it. So, let’s look at some conditions where this is common for people to experience this. 

What About Clinically? 

So, part of the issue with CS is that the CNS can change, distort, and amplify pain all without an actual noxious input. When we look at the lack of an injury, it may seem as though the pain isn’t real, but it most definitely is.(3)

So, imagine what this is like for the patient sitting in front of you. Especially when there could be things like work-related compensation etc. involved. (3) 

Another aspect regarding this condition is that it is complicated to diagnose because we cannot measure sensory input. So, pain hypersensitivity alone isn’t enough to say someone has CS. Some of the things they look at to determine if it is CS are (and remember how I said ‘a whole host of molecular changes and activities in the spinal cord that lead to CS, but I’m not sure we have to know those specifics’): (3)

  • pain mediated by low threshold fibres (but they have to use nerve blockers and electrical stimulation to figure that out)
  • spread of pain sensitivity to other areas without any injury
  • aftersensations (prolonged sensation after stimuli has been removed)
  • something called ‘temporal summation’ (basically things happening at the action potentials of nerve conduction)
  • pain continuing on from a small stimulus that usually wouldn’t cause pain

So, clearly, for us as Massage Therapists we wouldn’t be able to develop an accurate diagnosis for one of our patients, as much of this would have to be seen under MRI. 

However, we can look at some conditions where we are more likely to see this as CS can influence the following:(3)

Rheumatoid Arthritis

  • during flare ups more pain in the joints and remote areas could set up a state of CS

Osteoarthritis

  • degree of pain does not always correlate to extent of joint damage or active inflammation

Temporomandibular Issues

  •  associated with increase in generalized pain sensitivity after isometrics of orofacial muscles
  •  widespread bilateral mechanical and thermal pain sensitivity in women
  •  greater referred pain from trigger points
  •  mechanical allodynia with inflamed teeth, don’t become a dentist

Fibromyalgia 

  •  several studies showed increased sensitivity to pressure, thermal stimuli, and electrical stimulation of muscle and skin support CS
  •  they use medications in this case to treat the CNS

Musculoskeletal conditions

  •  Whiplash
  •  shoulder impingement syndrome
  •  tennis elbow (widespread bilateral mechanical pain)
  •  deep tissue hyperalgesia in chronic radiating low back pain, with intervertebral disc herniation
  •  characterized by spread of pain and sensitivity to deep uninjured tissue

Headache

  •  spontaneous body pain and allodynia preceeding migraine attacks
  •  chronic tension headaches referring to hyperalgesia of neck muscles
  •  CS may contribute to to chronification of tension headaches

Neuropathic Pain

  •  studies have looked at things like carpal tunnel that had enhanced bilateral sensitivity and spread of symptoms with nerve entrapment which supports CS

Complex Regional Pain Syndrome

  •  presents with increase in tactile and pressure invoked pain, presence of contralateral hypersensitivity in the absence of any inflammatory process

Post Surgical Pain

  •  depends on anasthesia and very important during recovery

Visceral pain

  •  IBS/referred pain – use local rectal anasthesia to help
  •  Non-cardiac chest pain have esophogeal  hypersensitivity   
  •  chronic pancreatitis – generalized deep pressure hyperalgesia
  •  urological tract hypersensitivity associated with: 
  •  interstitial cystitis
  •  chronic prostatitis
  •  endometriosis
  •  vulvodynia

Comorbidities

  •  fibromyalgia, tension headache, tmj, IBS
  •  no inflammation or cause which suggest CS
  •  good chance of genetic factors
  •  can contribute to depression, fatigue, joint pain

Okay I get it, that’s a LONG list. This post was intended to be a way to simplify what CS is, but there really are no ‘simple’ answers, especially for what we do to help patients. So there may not be a lot we can do treatment-wise, but what’s really important is to recognize what the person is going through. They may not get a CS diagnosis; they may not get any kind of diagnosis at all. 

And we know that patients (and insurance companies) really want to get a diagnosis to understand what is going on. So, our role may be to simply VALIDATE, VALIDATE, VALIDATE, the person sitting in front of us. You may be the first person who believes this person is in pain. Take the time to listen to them, let them talk, and support them! While you will likely have to adjust the pressure you use during treatment, those treatments may become supported self-management, and you may become their biggest ally for their journey. I don’t know to this day if that person I saw while I was a student had CS, I just hope I did a good enough job of minimizing their pain and feeling good, even for just an hour at a time. 

If you’d like to get more in-depth with the topic of Central Sensitization, Dr. Melissa Farmer has a great four-part series on the topic which you can read HERE

References

  1. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. The journal of pain. 2009 Sep 1;10(9):895-926.
  2. Tsagareli, Merab. (2013). Pain and memory: Do they share similar mechanisms?. World Journal of Neuroscience. 3. 39-48. 10.4236/wjns.2013.31005.  
  3. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011 Mar 1;152(3):S2-15

 

Downplaying Pathology

One of my favorite podcasts is Dr. Oliver Thomson’s Words Matter. Through his podcast, Dr. Thomson addresses a wide range of topics relevant to my practice, both as a physical therapist as well as an educator. While an entire hour spent unpacking concepts surrounding the way a clinician approaches a patient presenting with back pain may sound rather niche-y and not of particular interest to an SLP, voice professional, or other professionals, but the episode that I just finished listening to is completely relevant for all of us. If you can broaden the context to include all aspects of diagnoses and envision how our patients enter our clinic, you’ll see the immediate relevance of the information covered in this episode.

One of the takeaways is revealed in the portion of the talk that looks at patient expectations in how we assess, and the expectation of all of the things that we will find wrong with the patient.

Much of this feeds into the traditional medical model that is ramped up in manual therapy evaluations. Our patients pay us to find out what is wrong with them and then do things to make them less wrong. In past articles I’ve covered my views on concepts of causation and pathology and how, when presented in the silo-based format of a specific manual therapy mindset, makes us seem the expert on finding problems with their fascia (or joint, or muscle, or trigger points).

They expect this from us, but by telling them what is wrong, we may be doing a disservice at many levels.

First off, our silo-based training makes every problem look like a problem based on our training. In my post life as an MFR therapist, every problem was explained in fascial-based language. But that language, and the concepts that underpinned it, are not ones accepted by the outside medical community.

So by telling my patient what was wrong with their fascia, I may have been telling mistrusts.

Second, by telling what is wrong with them I am reinforcing how broken they are. Sure, I am offering solutions (my services), but layering on pathological perceptions builds strongly on nocebic concepts (not a good thing).

In the podcast episode, Dr. Thomson and his guest, Dr. Ben Darlow, speak about how reinforcing the positive during an evaluation can step our patients back from the edge of feeling broken. While most want a diagnosis, what most really want is reassurance that they are NOT broken.

Most patients come to us having seen a few other professionals and, most likely, have been told some rather sorry explanations for why they are having problems. 

If the poor input came from someone at the top of the food chain, such as the ortho surgeon, or similar, those explanations are hard to undo. One cannot forget what they’ve already heard. But many of the bad explanations for problems come from those on a equivalent level, professional-wise. It’s not easy to undo the crappy thoughts injected into our patient’s brains by others, but we can start by telling our patients what is NOT wrong as we assess. The podcast explains this much better than I can, and there are a whole lot more gems that I believe all will benefit from.

You can listen to the entire podcast from the links at this page.

People Don’t Follow Guidelines For Back Pain Because There Is No Path To Follow

I get the opportunity to chat about back pain now and again around the world and one of the things I often talk about is the current guidelines around back pain. I will admit to often feeling a little apprehensive around this subject as the current guidelines run contrary to the way many HCP treat this common problem.

There is always a little gasp when manual therapy, acupuncture and ultrasound get relegated to adjunctive treatments. “Don’t shoot the messenger” is often my get out of jail card.

We know that clinical guidelines around most things within healthcare are not well followed. The big question is why?

We Are Humans!

Healthcare professionals are humans just like the people we are trying to help and suffer from exactly the same issues. For me there are parallels between getting clinicians to follow guidelines and getting people to be compliant, adherent, committed or whatever you want to call it to exercise programs or health improvement or even taking medications.

We all know that getting fitter is good for us as is reducing smoking, drinking and eating crappy foods. But that does not mean we always implement this knowledge. People still smoke and drink too much and don’t get the recommended dosages of exercise. Big societal messages are needed, but so is how to put them into practice at an individual level.

The big problem I see is how gigantically broad the guidelines are around treatment. Let’s take my favourite subjects’ activity & exercise, the guidelines are clear, movement is good, but the evidence base is not really clear when it comes to putting these recommendations into practice!

We might ask ourselves which exercise? How much? How should they do it? What should it feel like? Might it make the problem worse? How to get people to actually do it? If I look back at my clinical education in back pain treatment mostly it was based around Maitland mobilisations with little about exercise treatment and implementation.

So a simple guideline turns into a much greater clinical problem.

Providing A Path

Fundamentally we cannot expect people to implement something without giving them a way to implement it. We need to provide a pathway in much the same way we need to provide a pathway for the patients we work with around exercise.

How can you guide someone in something of you have no idea how to do it yourself?

Imagine getting a bit of flat pack furniture that did not come with any instructions. The pile of pieces that lay in front of you daring you to put them together. Some hardy souls, and probably those with a heap of previous experience, might attempt to put them together. Most normal folk, myself included, would simply put them back in the box and push them to the corner of the room. This conundrum is simply too much to handle.

You have all the pieces of the puzzle, but the problem is putting them together!

Education is another prime example. Education about what? Back pain? Pain? Treatment? Prognosis? All of the above? How to do it? Again there are many questions to unpack within the broad recommendation of education. I received no education in education at undergrad or post grad as I suspect neither have many of you reading this. Again this provides a barrier to implementation at the most basic level.

In the face of uncertainty and low confidence we return to our old habits that are ingrained within us and for many that is not based on current guidelines. Uncertainty provides huge inertia to change.

Support

Support is another factor that is often overlooked. How many people feel they cannot treat how they want to treat because of the working environment they are in and the people around them? This is something I often hear. Support again is a huge part of behaviour change and maintenance of that behaviour. A major part of self efficacy is built around social support and I doubt that it would be different in the work place.

The healthcare system that people work in can be a huge influencer of the way we practice in the same way our social systems affect our overall health and behaviours.

Takeaways

 

• Behaviour change is no different for HCPs than it is for patients

• If we want change we have to provide a path to change and support along the way

Why You Matter More Than Your Technique

Remember the first two terms of college? 

I remember it being REALLY stressful; in fact, they always said if you could make it through term two, you would be okay because it was the toughest. 

However, this was when we learned most of our technique classes. For us, term two was when we had a class called “Myofascial Release II .”

We learned a technique in that class that I still use today. The “Occipital Hold,” and we were taught how this was releasing the fascia around the occiput. 

Then five terms later, we had two more technique courses. One was MLD, and the other was Craniosacral. I don’t remember who taught us Craniosacral, but I probably owe them an apology. I was a bit of a jerk in that class because…well, I couldn’t feel the rhythms and pulses as it was being taught. As other students would exclaim how they felt these rhythms, I’d look across the room and say, “you’re full of s#*t you can’t feel anything!”

It wasn’t my finest moment; clearly, my ego and lack of palpation skills were at play, and I’m sure I owe some classmates an apology as well. 

The interesting thing is one of the techniques they taught us in that class was an occipital hold. With this technique, we were supposed to be altering the rhythm or flow of cerebrospinal fluid (I’m saying this strictly from memory as I haven’t studied any craniosacral since that time) along with possibly altering sutures in the skull. 

Now, I wish I could say I was some forward-thinking student that realized this at the time, but I only came to this revelation a year or two ago. 

Those two classes taught me the exact same technique but with wildly different explanations of what was going on. 

So, which one was right?

The Mechanisms Of Manual Therapy

An excellent paper was done, which looked at modelling a new approach to how studies in our field should be designed to understand better how to advance what works in our profession and what doesn’t. 

Part of the problem with many of our profession’s modality courses is how there seems to be a one-size-fits-all approach. That one technique can work on anyone for almost anything.(1) 

Well, there’s a lot more to a treatment than just the technique we use. So we can’t justify saying there is a “single thing’, or “single technique” that works exclusively on any given subject.

We know the mechanical stimulus from any manual therapy technique regardless of the intervention (joint mobs, spinal manipulation, Swedish massage, myofascial release, etc) results in neurophysiological responses in both the peripheral and CNS to help with pain inhibition. (1)

This helps demonstrate why we can’t take a mechanistic approach to treat patients. As the paper points out, to have a mechanical based approach, there are two prerequisites needed: 

  1. A mechanism contributing to a clinical population or subpopulation. 
  2. Biological effects of treatment have to be established. 

If both of these are met, a patient could then be matched to appropriate treatment (or technique), allowing for targeted application of that specific treatment. (1)

The issue here is there is no way to identify the main mechanisms of how any technique works. 

Now, I know that will ruffle some feathers as we quite often become attached to our favourite technique (and in no way am I saying you have to stop using the said technique; I encourage you to keep using it). Still, much of the research behind many of these techniques aren’t reliable. Often, the study is being done by the person who created said technique to prove its validity. And most of the time, they have excellent outcomes to prove their efficacy. 

However, what they aren’t taking into account is the contextual effects of what they’re doing. As this paper points out, this is a crucial part of any manual therapy intervention. 

How Our Treatments Are Multi-Faceted

There is far more than just our hands-on techniques that influence treatment outcomes. 

Just some of the non-specific factors to include are:(1) 

  • Patient beliefs
  • Provider beliefs, confidence, demeanour
  • The environment the treatment is provided in
  • Therapeutic relationship
  • Influence of community factors on the patient

There are many more but with this brief overview, let’s consider how this could influence research outcomes when strictly focused on a technique. 

If a patient believes the technique will help, well, it probably will. 

If the provider is trying to prove the efficacy of a said technique, chances are they are very confident of their proposed outcomes. They have probably also used the technique often, so they are quite capable and confident with the hands-on portion of using it. This would also influence their demeanour during their interaction with the patient, which also helps with a therapeutic relationship. 

Even the setting where the treatment is delivered can influence the outcome. For instance, an athlete would likely have a better result receiving treatment within the facility of their chosen sport. Someone with headaches would probably have a more significant effect in a darker room with less noise. 

So many of these contextual factors come into play; it demonstrates how we can’t strictly focus on one intervention or technique to show its effectiveness. 

As well there is this other wonderful thing called “Clinical Equipose.” 

We have touched on this in the past but essentially, what it means is a clinician having no preference as to what modality or technique they use. 

This is very important because bias towards a treatment is also associated with clinical outcomes. Because if a clinician believes a technique works and their expectation is that said technique always works, their expectations influence the outcome. 

Clinical Equipose is essential in a research setting because if the provider doesn’t care or isn’t invested in a particular technique, there can be no bias towards the intervention. As we have seen, this bias can influence outcomes. 

When we look back to my story from college and ask which technique description was right, the reality is neither one was right, but this is still a great technique. 

We know that what we do with our hands is a mechanical stimulus that results in neurophysiological responses to the nervous system. Everything we do is an influence on the nervous system. When we look at the occiput, this is an area that is HIGHLY innervated with nerves, and being nicely touched in the area feels really good! This is why an occipital hold is such a GREAT technique. So while we challenge the premise of some modalities (honestly, I wasn’t trying to pick on MFR or CST, it’s just a good example), it doesn’t mean we have to stop doing them. 

However, we have to look at the reasons why these work with the people we see. First off, your patients like you, and you do a good job. You’re confident with your skills. They come to your clinic with an expectation that you’re going to help them (and you do!). Their preference is to see you because they like what you do. Their belief system is that you’ve helped them in the past, so you’re likely to do so again. 

What we do have to change is the narrative behind some of these techniques. They’re not doing what many of us were taught, but they feel outstanding. So, if it feels good, you’re confident with them, and your patients believe you will help them, isn’t that better than a description that isn’t really plausible?

Oh, and to all my classmates and that teacher, I apologize. 

 

If you haven’t checked out our new podcast, head on over and subscribe HERE

References

  1. Bialosky JE, Beneciuk JM, Bishop MD, Coronado RA, Penza CW, Simon CB, George SZ. Unravelling the mechanisms of manual therapy: modelling an approach. Journal of orthopaedic & sports physical therapy. 2018 Jan;48(1):8-18.

The Muscle Of The Soul, Or Just A Good Stabilizer?

It may be the most popular muscle in the world. 

For some reason, it gets a lot of credit for things and stirs up more debate than any other muscle (at least from what I’ve seen). 

Yes, we’re talking about the muscle of the soul! The wonderful Psoas. 

It’s been given credit for many a thing, including but not limited to: 

  • anterior pelvic tilt
  • breathing disruption
  • manifesting physical symptoms of fear
  • knee pain
  • digestive problems
  • low back pain
  • and even somehow is part of our reptilian brain?

Whoa, this muscle is doing a lot!

When we look at some of these statements, they are often prefaced with “believed to,” and while people are entitled to believe whatever they want, some of these things are also taken as fact within our profession. 

When I was in college, this was often touted as the main reason people have low back pain. 

The muscle’s biomechanics showed us how a tight psoas was creating an increased lumbar lordosis when it was in a “shortened” position in everyone from office workers to cyclists. 

But what does the updated research say? Well…let’s get into that!

Biomechanics

First, it’s probably important to do a quick review (and yes, I had to look this up). 

It starts on the transverse process of T12-L4 as well as the intervertebral discs and inserts on the lesser trochanter of the femur. 

This research article(1) takes that a bit deeper and shows there are attachments on the anterior part of all lumbar TVP’s and the anteromedial aspect of the lumbar discs and bodies except on the L5/S1 disc. Where it attaches to the TVP’s is considered the posterior attachments, whereas the disc and bodies’ connections are considered the anterior attachments. There was an argument that those anterior attachments would pull the lumbar spine into and increased lordosis, but that  was with an assumption the attachments were more on the anterior surface of the vertebral body, not the TVP. 

When I was in school (and granted that was quite a while ago), we were taught that Psoas was primarily a hip flexor that worked along with Iliacus to accomplish the movement. However, some more recent studies(1) have shown it plays some other roles, including: 

  • advancing the lower limb while walking
  • controlling deviation of the trunk while sitting
  • some action with rotation, abduction, and adduction of the hip
  • lumbar spine stabilization
  • hip stabilizer

Interestingly, the study (1) looked at how the Psoas influenced hip pain in a hockey player, but not much discussion around low back pain. 

So, is the Psoas a culprit for patients presenting with low back pain?

Size And Role

A couple of studies looked at Psoas under MRI to compare cross-sectional size between those with low back pain and those without, and the results are pretty to interesting. 

They found those patients dealing with low back pain had a larger Psoas Major than those without pain. (2)

One possible reason for this is that Psoas is a lumbar spine stabilizer; the muscle’s hypertrophy was due to increased activity in those with some degenerative disorders in the lumbar spine, so it’s working as a support or protection for the area. (2)

When they looked at fat infiltration and whether it plays a role, there was a correlation with some atrophy of the lumbar paraspinal muscles, which would cause Psoas to increase its activity as a stabilizer for the lumbar spine. However, there was minimal infiltration of fatty tissue within Psoas. 

One other study looked at how Psoas was affected in older generations and did show there was a difference in size between men and women, which is likely due to hormone deficiencies after menopause. (3)

When there were degenerative changes with the lumbar discs or segmental instability in the spine, they noticed that Psoas actually got smaller. However, this is likely because more pain is associated with these degenerative changes, so the size change is because of disuse. This could also directly correlate to fear avoidance, where a person stops certain activities because they’re worried about reinjuring the area or making it worse, especially after getting what sounds like a scary diagnosis. 

To me this is a little bit of a chicken or the egg. Could Psoas be causing pain, or is it’s size adapting because of pain resulting from something else? I’d argue it’s the latter.

So now we understand that Psoas is more of a support to the lumbar spine rather than something that is pulling it into lordosis or causing pain; the question remains…do we treat it?

Well, there’s a lot of controversy around this, and I’d say it depends.

Although I know if I do a treatment in this area in the way I was shown in school, I can definitely feel the psoas “pop up” under my fingers. However, we also know there is A LOT of stuff in the way to be able to palpate something that deep. Because in reality, we can’t palpate something that deep even though we can feel it “pop up”. 

I have a person who comes in once a month for treatment and really enjoys getting their Psoas worked on. They feel it benefits them greatly for the activities they participate in. So, yeah, I’ll treat it for them. However, if this was a new person coming in and saying their back pain is a result of the Psoas, well then I’d be digging a bit deeper into their reasoning and having more of a conversation to educate them on how Psoas is probably helping more than it is causing an issue. It’s one of those things where our clinical experience and decision making have to come in to play. Some say we should never treat the area but we also have to take patient preference into account and what they believe will help them. If you’ve been treating the area and having reasonable success and your patients like it, then keep on keeping on. But change the narrative around it. Take the time to educate a little and see if it’s really necessary. Especially if you’ve been giving this kind of treatment and the person is uncomfortable during the treatment (let’s be honest, it’s a pretty sensitive area), then offer to change things up and try something different. Just make it a joint decision between the two of you and strengthen that therapeutic relationship. 

If you haven’t subscribed yet, check out our new podcast HERE, we’ll be discussing Psoas this week and discussing some of the research around it. 

References

  1. Sajko S, Stuber K. Psoas Major: a case report and review of its anatomy, biomechanics, and clinical implications. The Journal of the Canadian Chiropractic Association. 2009 Dec;53(4):311.
  2. Arbanas J, Pavlovic I, Marijancic V, Vlahovic H, Starcevic-Klasan G, Peharec S, Bajek S, Miletic D, Malnar D. MRI features of the psoas major muscle in patients with low back pain. European spine journal. 2013 Sep;22(9):1965-71.
  3. Sions JM, Elliott JM, Pohlig RT, Hicks GE. Trunk muscle characteristics of the multifidi, erector spinae, Psoas, and quadratus lumborum in older adults with and without chronic low back pain. journal of orthopaedic & sports physical therapy. 2017 Mar;47(3):173-9.